Hyperlipidemia, hypertension, and accelerated atherosclerosis are present not only in chronic hemodialysis patients but also in recipients of successful renal transplants. We aim to determine whether an alternate-day corticosteroid regimen reduces the prevalence of these two atherogenic risk factors in comparison with a daily regimen as suggested by our retrospective studies. We will carefully describe plasma lipids in renal transplant candidates and, after successful transplantation, randomly allocate these patients to either a daily or an alternate-day corticosteroid regimen. Plasma lipids and blood pressure will be studied when maintenance immunosuppression is achieved. To define the specific effect of corticosteroid dose spacing on these risk factors, plasma lipids and blood pressure will be serially studied in a separate group of stable normotensive, normolipidemic renal transplant recipients currently on alternate-day steroids during 6 months of a daily regimen and again during reinstitution of alternate-day therapy. Concurrently, the effect of daily vs alternate-day steriod regimens on the production and removal of increased plasma triglycerides induced by corticosteroids will be studied in the rat. These studies will demonstrate the effect of corticosteroid dose scheduling on two important atherogenic risk factors and may offer therapeutic alternatives to patients receiving chronic corticosteroid therapy.